Physician laments the end of a more personalized practice

Do you remember when we were truly a service economy? The milkman came to the
house; bread and cakes were brought to the door; airport service agents checked
you in and made accommodations; most pharmacies delivered, and the supermarket
had check-out people and baggers that helped you to the car. The list could go
on and on.

Dr. D'Angelo

Progress, in many ways, has eliminated service and it is my profound belief
that we are witnessing the last generation of the private doctor’s office. The
future proposes better healthcare outcomes by creating larger healthcare groups
that coordinate care. We all know, however, that this is likely to come with a
price of greater impersonalization.

If your personal doctor is such a good thing, then why is he vanishing? The
economics of healthcare delivery and the interests of the insurance industry are
deeply rooted in greater control over providers and how they work.

In 1988, when I first started in practice, my office overhead was about 40
percent. Since that period of time, greater regulations and mandates, along with
confounding insurance policies and payment procedures and increasing benefit
costs have resulted in an office overhead of close to 70 percent.

‘FREE’ SERVICES

Our federal
decision makers seem to have no understanding of the costs of their regulations
and the simple economics of healthcare at a grass roots level. They appear to be
constantly disconnected from the conversation of everyday Americans.

Have you ever noticed when they talk about Medicare they make it sound like a
free entitlement? Most of us know we pay for Medicare through our taxes during
our working lives, and when we actually use it, we pay a monthly premium. This
is not free.

Rising Medicare costs will also eat into seniors’ Social Security benefits.
The average Part B plus Part D premium is estimated to equal about 12 percent of
the average Social Security benefit in 2010, and 16 percent of the average
benefit in 2025. Cost sharing adds to this burden, on average, another 15
percent in 2010, and 19 percent by 2025.

Privacy rules, electronic medical records, greater scrutiny over
prescriptions and the power of insurers to limit benefits and create greater
hoops for approval processes now means that each office has eight people for
every doctor. We are sold these processes on the basis they will improve
healthcare outcomes, however, this is more an anticipated wish than actual
reality.

In addition, health insurers act as though they have the unbridled ability to
reduce what they pay doctors and hospitals, while at the same time they increase
the cost to the consumer every year. They do not bear any of the burdens of
these costs, and they are under no obligation to reimburse at a higher rate to
pay for these services.

The insurance industry seems to have a great business formula: If they pay
out more than anticipated, they simply increase the premiums. The healthcare
provider does not operate in this model and is facing greater pressures to meet
payroll and administrative costs for a complicated system.

PATIENT PROTECTION

In March 2010, the Patient
Protection and Affordable Care Act, sponsored by the Democratic 111th Congress
and the Obama Administration, became a law and made changes in health insurance
procedures. The act is expected to drop the levels of uninsured people by 32
million, but will still leave 23 million residents uninsured by 2019, after the
bill’s provisions have all taken effect.

While it hasn’t solved the problem of the uninsured or under-insured, it has
essentially fostered the concept of larger group practices in order to earn
performance payments. This is a short-term concept geared at encouraging
providers to join larger groups, and eventually this benefit will vanish.

Physicians and healthcare providers operate in an unfair marketplace. We have
no control over insurance negotiations for rates, no way to pass the costs of
increasing administrative burdens on to the system, and will be forced into
insolvency as a business entity. This will further increase the unemployed and
the uninsured.

The patient affordable care act was a bold step forward, but it stopped short
of true health insurance reform. Any of the reforms proposed have just resulted
in increased premiums.

The everyday American will have a hard time competing with the lobbying power
of the insurance and pharmaceutical industry. So change will happen, and while
the model will change, there will still be doctors and nurses trying to provide
the best care possible. This will just be another service that vanishes in the
name of efficiency.

Americans need to speak out clearly about what they expect from health care
in the future. Politicians need to be held accountable when they do not hear us.
They are not a privileged class. They are public servants who need to be
operating in the citizen’s vision of tomorrow. I, for one, will miss knowing my
patients well.

This column is provided by the
Richmond County Medical Society. The author, Dr. Jack D’Angelo, is a past
president of the Society. He specializes in Physical Medicine and Rehabilitation
and maintains a practice in the New Dorp and Charleston areas of Staten
Island.